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Social Determinants of Health

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From:
Dennis Raphael <[log in to unmask]>
Reply To:
Social Determinants of Health <[log in to unmask]>
Date:
Wed, 17 May 2006 06:57:01 -0400
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My little contribution to the debate about poverty, policy, and change...

      Olin Wright argues there are important political implications that
flow out of these differing views.  The first view -- poverty as a
by-product -- argues that the poverty reduction task will be advanced by
developing numerous employment and training programs and policies and
showing policymakers that these programs and policies will work to reduce
poverty. Since no one really benefits from poverty -- according to this
view -- the task is one of educating and enlightening those in power as to
these various poverty solutions. According to this view says Wright, there
may be some myopia among policymakers and decision makers as to the causes
and solutions of poverty, but there is really little if any malice among
these individuals.
      In contrast, the class exploitation view of poverty argues that the
reduction of poverty will require the defeat of powerful forces that
benefit from poverty. These forces also include policymakers who are under
the control of these powerful forces: "The persistence of extreme levels of
poverty occurs not because powerful elites have mistaken ideas of what is
in their interests and what would solve poverty, nor because they are
short-sighted or unenlightened, but because they benefit from the existence
of poverty and have unchallenged power" (Wright, 1994), p. 38).
      Of course this raises a similar question asked earlier: Why do some
modern capitalist economies have high levels of poverty while other modern
capitalist economies do not? For Wright and other Marxist-oriented writers,
the answer is in political forces that are able to challenge those who
benefit from poverty.  This raises the question of the role of the state.

The State
      There are diverging views as to the influence and power wielded by
governments in nations with capitalist economies. The Marxist view is that
the state - federal, provincial, and local governments - reflects the
interests of the wealthy and powerful who own and control the economy.
Government officials - both elected and those high in the civil service -
are beholden to these forces for a variety of reasons (Brooks & Miljan,
2003).  The first is that any government action that threatens the
successful operation of the economy - continuing growth and expanding
profits - will threaten the very survival of the nation.  Policies that
threaten the interest of the owners of production will lead to credit
ratings being lowered, the flow of investment capital out of a nation, and
the decline of the economy and its associated standard of living. No
government - it is believed - can be elected under these conditions.
      The second reason why the state is beholden to these forces is that
the government officials and those high in the civil service come to share
the beliefs, values, and attitudes of these economic elites. These beliefs
include the perceived benefits of unrestrained capitalist economies, the
need to control labour and its allies, and the motivational importance of
poverty for keeping the population in line. If these beliefs are also
common to those citizens who make a point of voting, then consistency with
these beliefs assures future election success and employment for both
elected officials and higher levels of the civil service.
      In opposition to the Marxist view as to the subservient role of the
state, the pluralist view is that government policymaking is based upon
rational modes of policy analysis and planning (Brooks & Miljan, 2003).
Governments make policy decisions - it is argued - based on the marketplace
of ideas. New ideas compete against old ideas and if judged as having
reasonable chances of success are likely to be adopted. This view begs the
question of Why is it that nations and jurisdictions differ so
fundamentally in how the issue of poverty is understood and addressed?  All
policymakers around the globe are able to access the same body of research
literature concerning the antecedents of poverty and means of addressing
it.  There must be more to these decisions than competition of ideas in the
marketplace of public policy.

      Brooks, S., & Miljan, L. (2003). Theories of public policy. In S.
Brooks & L. Miljan (Eds.), Public Policy in Canada: An Introduction.
Toronto: Oxford University Press.
      Wright, E. O. (1994). The Class Analysis of Poverty. In E. O. Wright
(Ed.), Interrogating Inequality (pp. 32-50). New York: Verso.

From: Raphael, D., Poverty and Policy in Canada: Implications for Health
and Quality of Life.  Toronto:  Canadian Scholars' Press, forthcoming,
2007.

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